A complete clinical review of idiopathic macular telangiectasia

Idiopathic macular telangiectasia refers to a disease entity characterized by telangiectasia and alteration of the juxtafoveal capillary network. It can present uniocularly or binocularly and is subdivided into three groups which have varied appearances. Group I occurs in males which is easily identifiable and has macular edema. Group II has no sex predilection and difficult to distinguish by clinical examination and often requires the need of optical coherence tomography and angiographic modalities. Group III is not so common with its progressive nature and associated with neurological diseases. This article is aimed to provide complete details about idiopathic macular telangiectasia/idiopathic juxtafoveal telangiectasia/parafoveal telangiectasia including various groups, pathology, presentation, and management.

Outcome of Off-Label AREDS 2 Supplementation for the Treatment of Macular Degeneration in Non-Proliferative Idiopathic Type 2 Macular Telangiectasia

Purpose

To evaluate if off-label Age-Related Eye Disease Study 2 (AREDS2) supplementation prevents visual and anatomical deterioration in non-proliferative Idiopathic Macular Telangiectasia Type 2 (IMT2).

Patients and Methods

This is a single-center retrospective, comparative study of 82 IMT2 eyes treated with AREDS2 from January 1st, 2013 to January 1st, 2018. The study analysis consisted of a non-comparative arm, which included all AREDS2 eyes, and a comparative arm (27 AREDS2 and 42 untreated eyes) that only included eyes with complete follow-up data. Eyes were evaluated at baseline, 12 and 24 months. Better/worse eye sub-analysis was performed in the comparative study arm. Primary outcomes were best corrected visual acuity (BCVA) and optical coherence tomography (OCT) anatomical characteristics including largest cavitation diameter, central macular thickness (CMT), and length of ellipsoid zone (EZ) loss at 24 months.

Results

In the non-comparative arm, AREDS2 eyes showed stable BCVA (0.28 ± 0.18 logMAR at baseline vs 0.26 ± 0.19 logMAR at 24 months; p = 0.35) and OCT anatomical features after 24 months of supplementation. In the comparative arm, BCVA mean difference was greater for untreated eyes at 24 months (−0.09 ± 0.15 vs 0.03 ± 0.11 logMAR; p = <0.001). AREDS2 eyes had decreased cavitary diameter and EZ loss compared to untreated eyes at the study endpoint (p = 0.01 and p = 0.02, respectively). CMT remained stable for both cohorts throughout the study. For better/worse eye analysis, untreated eyes had worse BCVA at 24 months in both better and worse eyes (both p = 0.01). For anatomical outcomes, increases in both EZ loss (p = 0.04) and cavitary diameter (p = 0.001) among untreated eyes were only significant for eyes with worse baseline BCVA.

Conclusion

Our results suggest that off-label AREDS2 supplementation in non-proliferative IMT2 may prevent anatomical and visual deterioration in a subset of eyes.

Retinal circulation and its role in macular disorders in patients without systemic disease

AIM

To determine whether retinal circulatory changes play a role in the pathogenesis of macular disorders in patients who are otherwise healthy.

METHODS

Patients with macular disorders that required angiographic imaging were included in this prospective case series. After a complete ocular exam, fluorescein angiography was performed using a standardized technique on the HRA-II (Heidelberg Engineering, Heidelberg, Germany) with special focus on the posterior pole. Only patients with good quality images were included in the analysis. Circulatory parameters recorded included the arm-choroid time, choroid-retinal artery, and finally the retinal artery-vein time. Zonal asymmetry (between the upper and lower zones divided by a line passing through the centre of the fovea) in transit times, if any was also noted. Appropriate statistical analysis was done. Circulation times were compared with age matched historical controls. Changes in retinal dye transit times relative to historical age matched controls, if any, were noted and compared between various disorders.

RESULTS

A total of 156 eyes of 156 patients (120 males) were included in the study. Mean age: 49.14±14.93y. Macular disorders studied were age related degeneration, polypoidal vasculopathy, central serous chorioretinopathy (CSCR) and parafoveal telangiectasia. Delayed circulation time was noted in CSCR patients only.

CONCLUSION

CSCR patients appear to have delayed arterial filling, retinal circulatory disturbances do not seem to contribute to the pathogenesis of other macular disorders.

One-year results of verteporfin therapy for subretinal neovascularization associated with type 2A parafoveal telengiectasia

BACKGROUND

To report the 12 months follow up results of verteporfin therapy for subretinal neovascularization (SRNV) associated with type 2A parafoveal telangiectasia (PFT).

METHODS

A Prospective interventional case series. Patients who completed 12 months follow up following photodynamic dynamic therapy with verteporfin for subretinal neovascularistion with Type 2A PFT were studied. All patients underwent visual acuity assessment with ETDRS letter acuity chart at 4 meters, slit lamp biomicroscopy, fundus fluorescein angiography and photography. Treatment protocol of TAP study was followed. The follow up schedule was every month for 3 months and then every 3 months thereafter until 12 months. Primary outcome measure was the change in visual acuity and secondary outcome measure was the mean treatment rate. Improvement was defined as >/= 10 letters gain, stabilization as +/- 10 letters and deterioration as > 10 letters loss.

RESULTS

Twelve eyes of 7 patients received photodynamic therapy with verteporfin for SRNV with Type 2A PFT. Initial mean letter acuity was 25.4 and 23.4 at 12months (p = 0.7). At 12 months, one eye had > 10 letters gain, 2 eyes had >/= 10 letters loss and 9 had stabilized vision (+/- 10 letters). The mean number of treatment was 2.6. Ten (83.3%) of 12 eyes had retinal pigment epithelial collateral change, observed at the end 12 months.

CONCLUSION

Photodynamic therapy with verteporfin is effective in stabilization of vision in SRNV associated with type 2A PFT.